tci Part B Insider - 2012 Issue 44

Compliance: How To Win A ZPIC Appeal

What evidence is most compelling to auditors. Wading through the appeals process for Zone Program Integrity Auditor (ZPIC) audits is certainly daunting. But if you know what documentation will back up your claims and how to present your arguments, you may get a slam dunk on your appeal. If you’re unfortunate enough to have an unfavorable audit, you should know that ZPIC appeals work in the same way as other CMS appeals processes -- except for the potential inclusion of Medicare fraud issues. Here are some tips for winning a ZPIC appeal, courtesy of Medicare audit defense and...

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